Queen’s Speech

My Lords, it is a pleasure to see the noble Lord, Lord Darzi, in his place on the Front Bench, which he has come to occupy with such distinction over the past 12 months. I know that the House will wish to thank him for his opening speech, which sets the scene for today’s debate helpfully. I shall not attempt to compete with him in ranging over departmental boundaries, but will instead confine my remarks mainly to health-related matters. My noble friend Lady Verma will concentrate on education when she comes to wind up. Over the years of the current Government, this House has passed no fewer than 11 major Acts of Parliament originating from the Department of Health. The gracious Speech held out the prospect of another tempting morsel from that quarter. The NHS constitution has been in gestation for some time. I am not aware of any principled objection to it as a concept within the health service or within this House. In fact, my party has been quite enthusiastic about the idea of a constitution for some time, since long before the Government made their original announcement. In this respect, for us, the health Bill appears unlikely to turn into a major political battleground. However, there will probably be some aspects of the Government’s approach that we shall want to examine carefully. There does not seem to be much point in drawing up a set of regulations containing what everyone accepts are already the responsibilities and functions of the NHS and saying that the NHS must have regard to them, unless we see how this will add value to patient care. I need to understand rather better than I currently do what the practical implications of applying, or failing to comply with, the constitution will be for patients and staff and what ““having regard to”” will really mean. It is certainly helpful to articulate and assert NHS values. There are those who are apprehensive that, with the private and voluntary sectors playing an increasing part in the provision of NHS care, those values may not always be to the fore and who believe that we need the constitution for that reason if for no other. The trouble is that NHS values, as such, are apparently not to be included in the constitution. Nor are there any proposals to enshrine the principle of independent regulation of healthcare, which is so important if we are to have a genuinely patient-centred service. Rather mysteriously, two of the principles set out in the NHS plan have gone missing, including the principle that the NHS will support and value its staff. I would be interested to hear the Minister’s comment on that. We are told that one ingredient of the health Bill will be to strengthen public involvement in the commissioning arrangements of primary care trusts. It will be interesting to see what these provisions consist of. I say this with some degree of concern. Noble Lords will remember that, last year, we debated and passed the Local Government and Public Involvement in Health Act, which abolished patients’ forums and made provision for local involvement networks. LINks are meant to be in place and fully functioning across the country by the end of this month. Personally, I would be amazed if that happened. Everything that I and other noble Lords predicted during the passage of the Act has come to pass. There were meant to be transitional arrangements for patient and public involvement following the abolition of forums. Many local authorities have quite simply failed to understand the legislation properly and, in consequence, have failed to put in place those transitional arrangements. Information about the levels of service that host organisations have been contracted to deliver is being withheld, which makes it impossible to assess how well or badly they are doing. Many local authorities appear to believe that once a host is in place they have fulfilled their duties under the law—exactly the misconception that many of us fought so hard to avoid when we persuaded the Government to build transitional provisions into the Bill. The Government have made public money available to fund such arrangements. Despite that, many local authorities have refused to reimburse volunteers their legitimate expenses. The net result of all this is that many committed and talented people have given up the struggle and are now lost to the system. It is the perception of those who represent LINk members that Ministers are in denial about how bad the situation is in many areas of the country. If the health Bill is to depend on LINks to deliver the promised strengthening of public involvement in commissioning, we really must have greater confidence than many of us do have that they will be up to the task. I hope that the House will in broad terms welcome the idea of an NHS constitution, but at the same time we know that the main health agenda lies outside the strict confines of legislation. The noble Lord, Lord Darzi, is engaged in implementing his next-stage review. We should be in no doubt of the importance and magnitude of that task. One of the main challenges is to put in place mechanisms for drawing up so-called quality accounts. These in turn will depend on having appropriate quality indicators. I am right behind the noble Lord on this, but much will hinge on the ability of trusts to translate the data that they have into information that is useful and meaningful for patients. Trusts will also need to understand that collecting data and ticking boxes is not the end of the story. What will matter equally is whether they can take the relevant action if the quality of a service is found to be wanting. Infection control is one area that springs to mind; many argue that without good hygiene and infection control the quality agenda is hamstrung. A recent survey by the Healthcare Commission found that a quarter of trusts are failing to meet at least one standard on hygiene—standards that relate to infection control, decontamination of equipment and the healthcare environment. This represents practically no progress from two years ago. The Government said in 2001 that all new hospitals would have 50 per cent single rooms, which is absolutely key to tackling infections. In fact, 82 per cent of hospitals opened since 2001 do not have 50 per cent single rooms. The Health Protection Agency has said that three-quarters of hospitals could not isolate patients with an infection because they did not have the facilities. Actually addressing shortcomings in quality will be very difficult for some trusts. The Healthcare Commission’s annual health check provides other quality indicators. The overall picture is, thankfully, improving, the notable exception being London, where quality scores are lagging a long way behind those in the rest of the country. Quality accounts are not the whole story. A big part of what the noble Lord needs to create, as he well knows, is better standards of leadership. It was striking that, in the survey of NHS staff that the Healthcare Commission carried out last April, more than half those questioned did not think that the care of patients was their trust’s top priority. At one trust, only 3 per cent of staff thought that this was the case. How depressing. However, those findings illustrate, perhaps more than most others, what a job of work there is to do to make the values and principles of the NHS live in the minds of staff and how necessary it is for clinical leaders and NHS management to form more constructive working relationships. We are promised measures in the health Bill to extend controls over the supply of tobacco products. If measures can be taken that will lead to a reduction in the number of young people taking up smoking, I do not believe that any of us could oppose them. However, we have to be satisfied that any measures that are taken are backed by rock-solid evidence that they are likely to achieve that objective. One has to question seriously whether a complete ban on point-of-sale displays of cigarettes will meet that criterion. Contrary to the impression given in the departmental press release this week, the evidence from Canada and Iceland is at best speculative. Evidence needs to be stronger than that if a ban on point-of-sale displays is to satisfy the test of proportionality. There is no evidence that displays of tobacco products have got bigger or more prominent in recent years. When tobacco advertising was banned, the Government made an explicit distinction between advertising and display, display being, in their words, ““totally legitimate””. We have only recently changed the law to make it illegal to sell cigarettes to persons under 18. I supported that change. However, against that background the department needs to explain why banning point-of-sale displays is going to get us any further in preventing sales to minors. Indeed, if you take away the ability of cigarette manufacturers to compete with one another through point-of-sale displays, they will be left with only one other way of competing, which is through price. If a cigarette price-cutting war were to take place, it would have the very opposite effect to that desired. I am open to persuasion on the issue, but as yet I remain a sceptic. I am sure that I am not alone in looking forward to the coming Session, in which, as ever, we on these Benches will play our part in offering the Government our constructive comment and, where necessary, criticism. I have no doubt that today’s speakers will pave the way admirably across a wide range of issues for our debates in the coming weeks and months.